Tenet to pay Uncle Sam $513 million to settle allegations of paying kickbacks for referrals of undocumented pregnant Hispanic women

Tenet Healthcare will pay the United States $513 million to resolve a federal False Claims Act whistleblower case in which it is alleged that the company bought tens of thousands of referrals of pregnant Hispanic women, many who were illegal immigrants, from local clinics for which they were paid kickbacks. The case was filed by Ralph D. Williams who says he was fired in 2009 as chief financial officer of a hospital owned by Health Management Associates, Inc., after discovering the arrangement and voicing objections.

The Complaint, filed in the District Court in Athens Georgia stated that Hispanic Medical Management d/b/a Clinica de la Mama and other names, recruited pregnant, undocumented Hispanic women to its prenatal clinics with the well-publicized slogan: “we care about your health, not your immigration status.” The Complaint also stated that Clinica directs this vulnerable and malleable population of patients who will be Medicaid beneficiaries when they deliver their babies at the Tenet Hospitals and HMA Hospitals. It alleged that the Defendants Tenet and HMA intentionally pay illegal kickbacks for Clinica Medicaid patient referrals and submit false or fraudulent claims for payment to Medicaid for obstetric services provided to Clinica patients.

Normally,undocumented aliens are not eligible for regular Medicaid coverage. However the MEdicaid program does include Emergency Medical Assistance which pays for emergency services to eligible undocumented aliens including child birth. The U.S. Attorney’s Office in Georgia said that the agreement contemplates payment of $513,788,345 of which $368,000,000 is for the civil penalty and $145,788,345 is for the criminal penalty. Counsel for the whistleblower is Marlan Wilbanks.